MEDICARE: SALAZARS HEALTH IDEA, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	N5378	TX

General Provider Information

NPI Number	:	1497092506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALAZARS HEALTH IDEA, PA

Provider Business Mailing Address
First Line	:	27271 LAKE SHORE DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-2748
Country	:	US
Telephone Number	:	210-369-4667
Fax Number	:	210-369-4673

Provider Business Practice Location Address
First Line	:	615 NORTH MAIN STREET
Second Line	:
City	:	LA FERIA
State	:	TX
Zip	:	78559-5234
Country	:	US
Telephone Number	:	210-369-4667
Fax Number	:	210-369-4673

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. UBALDO JULIAN SALAZAR ALAMILLO
Credential	:	M.D.
Telephone Number	:	956-622-6394

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	05/02/2014

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